Stephany Renee Luchtefeld, NP
Individual provider Active NPI Nurse Practitioner · Bethalto, IL
NPI 1124515580 · NPPES record last updated May 31, 2018
Key facts
- NPI
- 1124515580
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 2017039611 (MO)
- Practice address
- 159 E McArthur Dr
Bethalto, IL 62010 - Phone
- (618) 258-7504
- NPI assigned
- Apr 20, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017039611 | MO | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 2017039611 | MO | Yes |
Addresses
Primary practice location
159 E McArthur Dr
Bethalto, IL 62010
Mailing address
200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698
Other names
- Ms. Stephany Renee Williams
Other providers in Bethalto, IL
- Melinda Lee Jones
- Angela Kage
- Thomas Lawrence Kaltenbronn
- Messina Lenger
- David Libbra
- Frank Lyerla
- Lynley E Atwood, LLC
- Rudy Mack
- Taylor June Maglasang
- Monica Marie Magowan
All providers in Bethalto, IL · Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.